All societies have norms of care and behaviour based on age,
life stage, gender and social class. These norms, often referred to as traditional
practices, may be harmless and beneficial, but some may be harmful. Female genital
mutilation is a key example of a traditional custom which is harmful and in some cases
fatal. Female circumcision is a form of violence which is an infringement on the physical
and psychosexual integrity of women and girls.

DEFINITION

"Female genital mutilation comprises all procedures involving partial
or total removal of the external female genitalia or other injury to the female genital
organs whether for cultural or other non-therapeutic reasons"

Female Genital Mutilation - A joint WHO/UNICEF/UNFPA Statement (1997)

BACKGROUND
& ORIGIN

TYPES OF SURGERY
There are five types of Female Circumcision from partial to complete clitoridectomy to the
removal of the labia minora and/or majora. The child is held down by three or four women
while the operation is being performed which lasts between 10 to 20 minutes.

The completion of the procedure is normally finalised by inserting a
match stick into the opening of the vagina to maintain a sufficient opening while the
surrounding tissue scars and eventually, if at all, heals. The instruments used vary from
razors, small knifes, broken glass to sharpened sticks which in nearly all cases are not
sterile. These instruments are used repeatedly on numerous girls, thus increasing risk of
blood transmitted diseases including HIV/AIDS. Cold water and shock are the usual
anaesthetics.

'Sunna' circumcision is the mildest, and least common form of
Female Genital Mutilation. It involves the cutting of the prepuce or clitoral hood. As
such it need not physically impair a woman's sex life, however due to the traumatic nature
of the custom, psychological problems are highly evident.

'Excision or clitoridectomy' involves the removal of the
clitoral glands or even the whole clitoris, surrounding tissue and/or labia minora. It is
the most common form of female circumcision and the medical problems associated with it
are paramount.

'Infibulation or Pharaonic' circumcision is the most severe and
radical form, involving the removal of the clitoris, the labia minora and majora, the two
parts of the vulva are then sewn together or through the natural fusion of the scar
tissue. What is left is a very smooth surface, and a small opening to permit urination and
the passing of menstrual blood. This artificial opening is sometimes no larger than the
head of a match. After the operation is performed, the child's legs are bound together to
impair mobility for up to 40 days.

'Introcision' is another rare form of female genital mutilation
reported to be practiced by the Pitta-Patta aborigines of Australia. When a girl
reaches puberty, the whole tribe - both sexes- assembles. The operator, an elderly man,
enlarges the vaginal orifice by tearing it downward with three fingers bound with opossum
string. This is usually followed by compulsory sexual intercourse with a number of men.

It is reported that 'introcision' is also practised in eastern Mexico,
Brazil, and Peru. In North-Eastern Peru, among a division of the Pano Indians, the
operation is performed in front of the whole community where an elderly woman, using a
bamboo knife cuts around the hymen from the vaginal entrance and severs the hymen from the
labia, at the same time exposing the clitoris. Medical herbs are applied, followed by the
insertion into the vagina of a penis-shaped object made of clay.

Unclassified includes pricking, piercing or incising of the
clitoris and/or labia : stretching of the clitoris, cauterization by burning of the
clitoris and surrounding tissue, introduction of corrosive substances or herbs into the
vagina to cause bleeding or for the purposes of tightening or narrowing it .

In all cases of female mutilation if the child dies from complications,
the excisor is not held responsible: rather, the death is attributed to evil spirits or
fate.

THE PROCEDURES DESCRIBED ABOVE ARE
IRREVERSIBLE AND THEIR EFFECTS LAST A LIFETIME

MEDICAL
COMPLICATIONS

SHORT TERM AND IMMEDIATE EFFECTS
Acute pain, shock, haemorrhaging, ulceration of the genital region, retention of urine,
damage to the urethra, anus and adjacent tissue, fractures or dislocations (when a
struggling girl is restrained) and a series of bacterial infections are the immediate
consequences of the operation. Most physical complications result from infibulation
although cataclysmic haemorrhage can occur during circumcision with the removal of the
clitoris; accidental cuts to other organs can also lead to heavy loss of blood.

Acute infections are commonplace due to operations being carried out in
unhygenic surroundings and with the utilisation of unsterilized instruments. Many excisors
apply traditional medicines to the wound. Examples include: mixtures of local herbs,
earth, cow-dung, ash or butter, and this often leads to infections which can lead to
tetanus and general septicaemia.

LONG TERM COMPLICATIONS
There are many long term effects of female genital mutilation including difficulty in
passing urine, recurring urinary tract infections, incontinence, pelvic inflammatory,
keloid scarring formation and sexual dysfunction. Haematocolpos, or the inability to pass
menstrual blood (because the remaining opening is often too small) can lead to infection
of other organs and also infertility. Fistulae (holes or tunnels between the vagina and
the bladder or rectum) is a common result of the operation. In some cases where
infibulation prevents or impedes vaginal intercourse, anal intercourse may be used as an
alternative. The resulting damage to tissue is also a possible route of infection by HIV.

Obstetric complications are the most frequent health problem, resulting
from vicious scars in the clitoral zone after excision . These scars open during
childbirth and cause the anterior perineum to tear, leading to haemorrhaging that is often
difficult to stop. Infibulated women have to be re-opened, or deinfibulated on delivery of
their child and it is common for them to be reinfibulated after each delivery. Although
little reliable data is available, it is likely that the risk of maternal death and
stillbirth is greatly increased, particularly in the absence of skilled health personnel
and appropriate facilities. Female genital mutilation may also be associated with long
term maternal morbidity.

PSYCHO SEXUAL AND PSYCHOLOGICAL HEALTH
Almost all types of female genital mutilation involve the removal of part or all of the
clitoris, which is the main female sexual organ. The more severe types, such as
infibulation, remove larger parts of the genitals and close off the vagina, leaving areas
of tough scar tissue in place of the sensitive genitalia, thus creating permanent damage
and dysfunction. This often results in sexual dysfunction in both partners causing painful
intercourse and reduced sexual sensitivity.

Genital mutilation may leave a lasting mark on the life and mind of the
woman or child who has undergone it. The psychological complications may be submerged deep
in the child's subconscious and may trigger behavioural disturbances. In the longer term,
women may suffer feelings of incompleteness, anxiety, depression, loss of trust, chronic
irritability and frigidity. Many women and girls, traumatised by their experience but with
no acceptable means of expressing their fears, suffer in silence.